The Health and Social Care Information Centre turns out streams of useful and important statistics. Unhappily much of this passes most of us by because we are busy doing things and need a nudge to look when something relevant has come to light. A recent entry tells a well-balanced tale of endeavour and success in dementia care: www.hscic.gov.uk/catalogue/PUB19812

This is exposed to the glare of publicity by the media in less sober and more scandalous terms:

For those most determined to see our diagnosis rate improved, the outcome may have justified the means. For others, like me, this seemed to be a demeaning way to treat a dignified profession – rewarding an activity simply by providing a monetary reward for a desired action. We were rebuffed by the observation that the same had been done to improve care for other illness conditions: The profession has been revealed to be corruptible or at least willing to be directed by carrots rather than its own mature and informed thinking.

I wonder what follows once the carrot has been consumed. What people need is the mature, informed guidance and care of their personal physician.

Prescriptions of cholinesterase inhibitors have increased six fold in a decade – perhaps a desirable phenomenon, and not as expensive as it would have been because the medicines are no longer under patent. But what people with dementia and their family need much more than these medicines is the mature informed guidance and care of a team of health and social care professionals to clarify what is happening to them and to support them through the journey.

I am really not sure what is happening with the follow through. My personal experience as I come near to ending my own clinical contributions is not reassuring.

In two services I have been associated with CCGs have withdrawn funding from models designed to provide support within primary care on the basis that ‘they are not working’. Published studies have demonstrated that such approaches have worked in other places – at other times. Perhaps there have been errors of implementation. Perhaps there are questions of commitment. Maybe it becomes impossible to be effective when social care funding is stripped away beyond a certain level.

In another setting, the model of referral to a memory service from 50 practices labours under the increased referral rate. Provision of confident and sufficient follow through is lacking both in the specialist service and primary care. It is wonderful to meet people and to help them in the first steps of understanding, but I am saddened and concerned for their futures.